Internship Research, (cont.)


Chapter Four: Maternal and Child Mortality

Today’s women face a crisis. Their healthcare needs are not being addressed and their current healthcare rights are being revoked. In South Carolina, women are at the mercy of state officials.  Women in South Carolina have been denied extra health coverage that has been granted to residents in Medicaid expanded states.  Also, women in South Carolina have been denied the right to an abortion after six weeks of conception. Expectant mothers are especially vulnerable, as South Carolina officials have been neglecting the needs of both pregnant women and their children. This is not a new issue, as this has been occurring for decades. The question is are South Carolina officials actively addressing the needs of women? Also, are we serving those populations that are most at risk?

South Carolina has several systems in place to monitor maternal health and child health issues. The Pregnancy Risk Assessment Monitoring System, also known as PRAMS, collects information on a women’s behaviors before, during, and after pregnancy. “The South Carolina Pregnancy Risk Assessment Monitoring System (SC PRAMS) Project plays a significant role in SC DHEC's public health surveillance activities. The SC PRAMS Project monitors and disseminates information on maternal behavioral risk factors occurring during pregnancy and on a child's early infancy period related to birth outcomes. Thus, the SC PRAMS Project provides sound and reliable maternal and infant health data, which can be used by health professionals for the planning and evaluation of perinatal health programs and for making policy decisions affecting the health of mothers and babies in South Carolina,” (About PRAMS, 2003). The PRAMS is an ongoing project that provides a variety of data on maternal and child health issues, but are those issues being addressed by South Carolina officials? Let’s go over the current status of maternal and child health in South Carolina.

Currently, South Carolina’s maternal mortality rate is 27.1 (per 100,000 live deaths). The national maternal mortality rate is 17.4. With the maternal mortality rate being higher than the national average, there must be an issue that is going unaddressed among expectant mothers in South Carolina.  The 2020 South Carolina Morbidity and Mortality Review Committee identified possible factors that could be contributing to the high mortality rate. The committee reviewed 27 maternal deaths between 2016 and 2019. After reviewing all data collected, the committee determined that 74% of the cases were pregnancy-related. The findings also determined that hemorrhage and infection were majors contributors to pregnancy-related death. The committee also determined that 55% of the pregnancy-related deaths were preventable. “The largest proportion of factors identified by the SC MMMR Committee as contributing to pregnancy-related deaths were patient/family factors followed by provider and systems of care factors. On average, five contributing factors were identified for every pregnancy-related death,” (South Carolina Maternal Morbidity and Mortality Review Committee Legislative Brief March 2020, 2020). In previous reports, cardiovascular, coronary, and embolisms were also cited as contributors to pregnancy-related death.  “From 2011–2013, 15.1 percent of U.S. pregnancy-related deaths were caused by cardiovascular disease, 14.5 percent by non-cardiovascular diseases, 12.7 percent by infection and sepsis, and 11.4 percent by hemorrhage. A legislative brief from the SC Maternal Mortality and Morbidity Review Committee finds that the most common causes of maternal death in SC are cardiovascular and coronary conditions, hemorrhage, infection, and embolism,”(Maternal safety comes in threes, 2019).  These causes have been cited at the national level as a recurring cause for pregnancy-related death. As I stated earlier, many of these causes are preventable. Health officials know that these causes can be prevented, yet they keep occurring. Two environmental factors are associated with increasing the risk for pregnancy-related death.  Those factors are provider factors and patient/family factors. Provider factors include, ignore patient concerns or misdiagnosing a health issue. Patient/family factors include not recognizing warning signs or not seeking care.

The healthcare needs of children are also going unaddressed. The infant mortality rate for South Carolina is 6.8 (per 1,000 live births), while the national rate is 5.7. For child mortality (individuals between the ages of 1-19), the rate for South Carolina is 33.2 (per 100,000 children). For the US, the rate is 25.7.  A report published by the South Carolina Department of Health and Environmental Control acknowledged the top five causes for infant mortality between 2017 and 2018. “The top five leading causes of infant death overall in 2018 were birth defects, disorders related to short gestation and low birthweight, accidents, maternal complications of pregnancy, and bacterial sepsis. From 2017 to 2018, there was a 28.1% increase in the number of infant deaths from birth defects (from 64 deaths in 2017 to 82 deaths in 2018). The number of deaths due to preterm birth/low birth weight and accidents increased from 2017 to 2018 by 11.5% and 11.8%, respectively,”(Infant Mortality and Selected Birth Characteristics 2018: South Carolina Residence Data, 2019). If the mother’s needs are not being, then it is likely that the child’s needs are being neglected as well.

We know the problem and we know there are systems in place to monitor them, but the question remains; are they being addressed. I believe the answer to this question is both yes and no. We know that in more metropolitan areas of our state these needs are being addressed more rapidly than in rural communities. We also have to remember that even if the individual has access to health services provider issues could still cause the individual to develop pregnancy-related complications. We also have to acknowledge that individuals of certain races experience maternal, infant, and child mortality at a higher rate, and thus need access to various medical services. It is apparent that the women and children in our state need expanded Medicaid services. Women need access to postpartum services and children need access to multiple health services. Expanding Medicaid services would ensure that the needs of both mother and child are being met. The priority of South Carolina officials should be ensuring that their residents are healthy and able to access health services should their health status change.

Maternal and Child Mortality Summary: The women and children of South Carolina are not having their healthcare needs met. The maternal mortality rate for South Carolina is 27.1, which is higher than the national average. When seeking to address why the rate was so high, I was again presented with the issue of pregnancy-related death. The 2020 South Carolina Maternal Morbidity and Mortality review revealed that hemorrhage and infection were major contributors to pregnancy-related death. This review also determined that 55% of the deaths surveyed were preventable. Cardiovascular issues have also been cited as a contributor to pregnancy-related death. Patient/family factors have been noted as the largest contributor to pregnancy-related death. Factors, such as home environment and proper nutrition may be part of the issue. The infant mortality rate for South Carolina is 6.8 (per 1,000 live births), while the national rate is 5.7. For child mortality (individuals between the ages of 1-19), the rate for South Carolina is 33.2 (per 100,000 children). For the US, the rate is 25.7.  If the needs of the mother are not being met, then we can assume that the child’s needs are being neglected as well. Birth defects and low birth weight are contributors to this issue.

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